Brief Report

Effect of Kangaroo Mother Care on Postpartum Depression

by Andréa Echeverria Martins Arraes de Alencar, Luis Cláudio Arraes, Emı́dio Cavalcanti de Albuquerque, and
João Guilherme Bezerra Alves
Instituto Materno Infantil Prof. Fernando Figueira (IMIP), Recife, Pernambuco, Brazil

Summary

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Postpartum depression (PPD) is a serious public health issue. Kangaroo mother care (KMC) is widely
considered to be the most feasible, readily available and preferred intervention for decreasing neonatal
morbidity and mortality in developing countries. We conducted a prospective study to assess the effect
of KMC on PPD. The study population included 177 low-income mothers with their preterm infants.
We used the validated Portuguese version of the Postpartum Depression Screening Scale for the
assessment of maternal depression. The mothers were evaluated twice, at Neonatal Intensive Care Unit
admission and at KMC discharge. We found 66 mothers (37.3%) with depression and it decreased to
30 (16.9%) after KMC intervention; p < 0.0001. None developed PPD during the Kangaroo stay.
We concluded that KMC may lessen maternal depression. Further studies, may be required to clarify
these preliminary findings.

Key words: postpartum maternal depression, Kangaroo mother care, preterm.

Introduction KMC are commonly analyzed in aspects of the

Postpartum depression (PPD) occurs following

10% of deliveries [1, 2]. Mothers of preterm infants
experience more psychological distress than mothers
of normal full-term infants in the postpartum period
and poverty is associated with twice the rate of PPD
[3–5]. PPD is associated with more severe depressive
symptoms, social dysfunction and marital maladjust-
ment than depression unrelated to the postpartum
period [6]. Well-controlled research trials have
revealed that PPD responds to treatment in the
short term with treatment roughly doubling the
spontaneous recovery rate [7].
The Kangaroo mother care (KMC) is based on
skin-to-skin contact between the mother and her
newborn baby, frequently a preterm or low birth
weight infant and has been used more in developing
countries [8–10]. KMC was initiated in Bogota [11]
and Instituto Materno Infantil Prof. Fernando
Figueira (IMIP) was the first hospital in Brazil to
adopt KMC [12]. It is now widely considered to be
the most feasible, readily available and preferred
intervention for decreasing neonatal morbidity and
mortality in developing countries [13]. The effects of
Correspondence: João Guilherme Bezerra Alves, Instituto
Materno Infantil Prof. Fernando figueira (IMIP), Rua dos
Coelhos, 300 – Boa Vista; Recife – Pernambuco, CEP:
50070-550, Brazil. Tel.: þ81 99746351; Fax: þ81 21224722;
E-mail: <joaoguilherme@imip.org.br>.
infant’s health, mother-to-infant bond and parent
satisfaction [14–16] but not to prevent or to treat
maternal PPD. We did not find studies that were
concerned with this. In order to address these
questions, we conducted a study to assess the effect
of KMC intervention on PPD in low-income mothers
of sick preterm births.
Methods
This prospective study was conducted in a teaching
institution with a tertiary level neonatal intensive
care unit (NICU) and a KMC in Northeast of Brazil
over a 8 month period; from December 2006 to July
2007. The study population included 180 consecutive
singleton intramural neonates with birth weight
<2000 g. Illiterate mothers, previous history of
depression and malformations of the infant were
excluded.
KMC was initiated when the baby was discharged
from the NICU and was stable. The mothers
provided skin-to-skin contact using a specially
tailored ‘Kangaroo bag’ made of soft flannel cloth.
The mothers were encouraged to keep the baby in
KMC as long as possible during the day and night
with a minimum period of 1–2 h at a time. All babies
were exclusively breastfed. Babies were monitored for
hypothermia, hypoglycemia, apnea, sepsis, feeding
problem and other morbidities. Babies who devel-
oped a life threatening event were considered as
critically ill and were withdrawn from the study.

ß The Author [2008]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org 36
doi:10.1093/tropej/fmn083 Advance Access Published on 9 December 2008
BRIEF REPORT

Babies were discharged when they showed a weight TABLE 1

gain of 10–15 g kg1 day1 for three consecutive Baseline characteristics of 177 mothers and their
days, were feeding well, maintaining temperature preterm neonates admitted to the IMIP, NICU,
without assistance and the mother was confident of 2006–07
caring for her baby.
We used the validated Portuguese version of the Mother characteristics n (%)
Postpartum Depression Screening Scale (PDSS) for
Age (years)
the assessment of maternal depression with a cutoff
10–19 47 (26.6)
score of 102, sensibility of 94%, a specificity of 95%, 20–34 107 (60.4)
a positive predictive value of 75% and a negative 35 23 (13.0)
predictive value of 99% [17]. The mothers were Gestation age (weeks)
evaluated twice, at NICU admission and at KMC 20  33 130 (73.5)

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discharge. 34 < 37 47 (26.6)
Written informed consent was taken from the Married 143 (80.7)
mothers enrolled into the study. The Ethical Review Schooling (4 years) 70 (39.5)
In come per capita (US$ 1.00) 147 (83.1)
Committee of the IMIP granted ethical clearance for
Pre-natal care (four or more appointments)115 (65.0)
this project. Pregnancy planning 121 (68.4)
Cesarean delivery 90 (50.8)
Statistical Analysis Newborn characteristics
Female 96 (54.2)
The difference in the rate of PPD between NICU
Apgar 500 <7 142 (80.2)
admission and KMC discharge was tested using Birth weight (<1.500 g) 77 (43.5)
the McNemar test; interpretation was done at 0.05 Mechanical ventilation 93 (52.5)

-level. Data analyses were performed using SPSS
version 10.0 (SPSS Inc., Chicago, IL, USA).
intervention to treat PPD with the exception of a case
Results study [20]. After participating in a KMC session, the
Three mothers were lost to follow-up. Baseline mothers reported improvement in feeling calmer,
characteristics of the 177 mothers and newborns are stronger, well-coordinated, energetic, contented,
shown in Table 1. We found 66 mothers (37.3%) tranquil, quick-witted, relaxed, proficient, happy,
with PPD at NICU admission within the first week friendly and clear-headed [21]. Such conditions are
of birth and it decreased to 30 (16.9%) at the KMC absent in the conventional care. These effects could
discharged (mean age of 49 days; range 20–64 days); minimize the risk for PPD. Another point is that
p < 0.001. None developed PPD during KMC stay. early cessation of breastfeeding or not breastfeeding
is associated with an increased risk of maternal PPD
Discussion [22]. In our study, all mothers were exclusively
In our sample, the prevalence of PPD at NICU breastfeeding.
admission was high (37.3%). Internationally, prev- However, our findings should be interpreted within
alence rates of PPD vary both within and across the context of certain limitations of this study. First,
countries, ranging from as low as 4.4% to as high our study was carried out only with low-income
as 73.7%, with a rate of 13% found following a mothers with their sick preterm infants. Second,
systematic review [18]. This is a wide variation in although the PDSS has been validated in Brazil, it
prevalence rates, indicating that there are inherent does not give a definitive diagnosis of depression.
difficulties in estimating them. This substantial Finally, our follow-up was short and we did not
variation may be attributed to measurements used, follow a control group.
sampling methodologies, socio-demographic var- In conclusion, KMC may lessen maternal depres-
iances, parity, timescale of the study and cultural sion. Further studies, may be required to clarify these
diversity [19]. We studied low-income mothers during preliminary findings.
the period immediately after childbirth of preterm
births with critical conditions needing NICU admis-
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